Patricia Beldotti, Psy.D.
Licensed Psychologist, Neuropsychologist

 Patient Forms
Please use our HIPAA-Compliant online forms below to 
contact us and submit forms.
Please complete our online New Patient Intake Form if you would like to have an assessment done.  This information will help us better understand your assessment needs. 
New Patient Intake Form
Brief Contact Form
Please complete our brief online contact form if you just want to ask
us a quick question.  
Comprehensive Adult History Form
If you are already scheduled for an appointment with Dr. Beldotti, please complete this extensive history form which will also ask you for details about current areas of concern.  These issues will also be discussed further with Dr. Beldotti at your appointment.  This form may take 1 hour or more to complete.  Please let us know if you need a paper form instead. This completed form must be submitted at least 4 days prior to your appointment.  If not received, your appointment will need to be rescheduled. 
Comprehensive Child & Adolescent History Form
If your child / adolescent is already scheduled for an appointment with Dr. Beldotti, please complete this extensive history form which will also ask you for details about current areas of concern.  These issues will also be discussed further with Dr. Beldotti at your appointment.  This form may take 1 hour or more to complete.  Please let us know if you need a paper form instead.  This completed form must be submitted at least 4 days prior to your appointment.  If not received, your appointment will need to be rescheduled.
Covid-19 Risk & Screening Form
This screening form needs to be completed for every patient who is or wants to be scheduled for an in-office appointment.  If you would rather go through these questions over the phone, please let us know and we will schedule a call with you.  If your appointment needs to be pushed back due to Covid-19 risk, we will get you in as soon as it is safe to do so.  You will not need to go on our normal wait-list.  Thank you for helping us keep you safe and everyone safe in our office!!!
Release Forms (To Print)
You can print and fill out these release forms if you need someone to send us your records (such as your doctor, therapist, a hospital, etc.) or if you want us to send someone a copy of your records (such as sending a copy of your evaluation report to your psychiatrist or primary care doctor).   You can also ask us to send you an electronic version of these forms that you can fill out and sign online.
Teacher Input Form
Family Member & Caregiver Input Form
This is an optional form for teachers to complete if one of their students is scheduled to come in for an evaluation with us.   It allows teachers to give information about the student's strengths and areas of concern.
This form is to be completed upon request for adult patients that are being evaluated for possible difficulties with functioning or thinking.  This form will be completed by a family member (spouse, parent, adult child, etc.) or caregiver who has knowledge of the patient's daily functioning and assistance needs.